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February 17, 2020

Role of Carotid Stents and Cerebral Protection on Cerebral Microembolization During CAS Evaluated

February 17, 2020—A study on the role of both carotid stent type and cerebral protection on cerebral microembolization during carotid artery stenting (CAS) was published by Piero Montorsi, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2020;13:403–414).

In the study, the investigators sought to randomly compare the double-layer Roadsaver stent (Terumo Europe) with the single-layer carotid Wallstent (Boston Scientific Corporation) in association with either distal embolic protection with the FilterWire device (Boston Scientific Corporation) or proximal protection with the Mo.Ma Ultra device (Medtronic) in patients with lipid-rich carotid plaques. The roles of stent type and brain protection during CAS remains unsettled, noted the investigators.

A total of 104 consecutive patients with carotid artery stenosis were randomized to CAS with FilterWire plus Roadsaver (group 1, n = 27), FilterWire plus Wallstent (group 2, n = 25), Mo.Ma plus Roadsaver (group 3, n = 27), or Mo.Ma plus Wallstent (group 4, n = 25).

The primary endpoint was the number of microembolic signals on transcranial Doppler among groups in the following CAS steps: (1 and 2) target vessel access; (3) lesion wiring; (4) predilation; (5) stent crossing; (6) stent deployment; (7) stent dilation; and (8) device retrieval and deflation.

In JACC: Cardiovascular Interventions, the investigators reported the following:

  • No significant differences in baseline characteristics among the four groups.
  • Compared with the FilterWire device, the Mo.Ma Ultra device significantly reduced mean microembolic signals count (P < .0001) during lesion crossing, stent crossing, stent deployment, and postdilation.
  • Compared with the Wallstent, the Roadsaver significantly reduced microembolic signals count (P = .016) in steps 6 to 8, including spontaneous microembolic signals (29% of patients).
  • Mo.Ma plus Roadsaver performed significantly better than Mo.Ma plus Wallsent (P = .043).
  • Clinical major adverse cardiac and cerebrovascular events occurred in three patients (P = .51).
  • After CAS, peak systolic velocity significantly decreased in all patients.
  • In-stent restenosis developed in one patient (0.98%) at 6-month follow-up.
  • Roadsaver was an independent predictor of external carotid artery patency over time.

In patients with high-risk, lipid-rich plaque undergoing CAS, Mo.Ma plus Roadsaver led to the lowest microembolic signals count, concluded the investigators in JACC: Cardiovascular Interventions.

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